Review Exercise F

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created 6 years ago by Erin_Cook_Phillips
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Problem solving for technical and positioning errors
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1

A three projection study of the hand was taken using the following analog exposure factors: 64kV, 1000 mA, 1/100 second, large focal spot, 36 inch SID, and high speed screens. Which of these factors should be changed on future hand studies to produce more optimal images

Use a small focal spot, minimum 40 inch SID, and detail screens to produce a higher quality study

2

A radiograph of a PA projection of the second digit reveals that the phalanges are not symmetric on both sides the of the bony shafts. Which specific positioning error is involved

rotation

3

A radiograph of a PA oblique projection of the hand reveals that the fourth and fifth metacarpals are superimposed. Which specific positioning error is involved

excessive lateral rotation

4

In a radiographic study of the forearm, the proximal radius crossed over the ulna in the frontal projection. Which specific positioning error led to this radiographic outcome

PA forearm projection was preferred rather than AP

5

A PA axial scaphoid projection of the wrist using a 15 degree distal CR angle and ulnar flexion was performed. The resultant radiograph reveals that the scaphoid bone is foreshortened. How must this projection be modified to produce a more diagnostic image of the scaphoid

the CR needs to be angled 15 degrees proximally, toward the elbow

6

A radiograph of an AP elbow projection reveals considerable superimposition between the proximal radius and ulna. Which specific positioning error is involved

the elbow is rotated medially

7

A routine radiograph of an AP oblique elbow with lateral rotation reveals that the radial tuberosity is superimposed on the ulna. in what way must this position be modified during the repeat exposure

increase lateral rotation of the elbow to separate the radius from the ulna

8

A radiograph of a lateral projection of the elbow reveals that the humeral epicondyles are not superimposed and the trochlear notch is not clearly demonstrated. Which specific type of positioning error is involved

the forearm and humerus are not on the same horizontal plane

9

A patient with a possible fracture of the radial head enters the ER. When the technologist attempts to place the arm in the AP oblique-lateral rotation position, the patient is unable to extend or rotate the elbow laterally. Which positions can be used to demonstrate the radial head and neck without superimposition on the proximal ulna

Coyle method for radial head (lateral elbow, CR 45 degrees toward shoulder

10

A patient with a metallic foreign body in the palm of the hand enters the ER. Which specific projections should be used to locate the foreign body

PA and lateral-in-extension projection

11

A patient with a trauma injury enters the ER with an evident Colles' fracture. Which positioning routine should be used to demonstrate the extent of the injury

AP and lateral forearm projections to include the wrist

12

A patient with a dislocated elbow enters the ER. The patient has the elbow tightly flexed and is careful not to move it. Which specific positioning routine can be used to determine the extent of the injury

two projections with acute flexion and lateral projection

13

A patient with a possible fracture of the trapezium enters the ER. The routine projections do not clearly demonstrate a possible fracture. Which other special projection can be taken

Modified Robert's Method

14

A patient with a history of carpal tunnel syndrome comes to the radiology department. The orthopedic physician suspects that bony changes in the carpal sulcus may be causing compression of the median nerve. Which special projection best demonstrates this region of the wrist

Carpal Tunnel position (Gaynor-Hart Method)

15

A patient comes to the radiology department for a hand series to evaluate early evidence of rheumatoid arthritis. Which special projection can be used in addition to the routine hand projections to evaluate this patient

Norgaard method ( ball catcher's position)

16

A patient is referred to radiology with a possible injury to the ulnar collateral ligament. The patient complains of pain near the first MCP joint. Initial radiographs of the hand do not indicate any fracture or dislocation. Which special projection can be performed to rule out an injury to the ulnar collateral ligament

PA stress (Folio method) projection

17

A patient enters the ER with a possible foreign body in the dorsal aspect of the wrist. Initial wrist radiographs are inconclusive in demonstrating the location of the foreign body. What additional projection can be performed to demonstrate this region of the wrist

Tangential projection - carpal bridge projection

18

A patient has a routine elbow series performed. The AP projection indicates a possible deformity or fracture of the coronoid process. However, the patient is unable to pronate the upper limb for the AP oblique medial rotation projection because of an arthritic condition. What other projection could be performed to demonstrate the coronoid process?

Trauma axial lateral projection - Coyle Method for corocoid process

19

Tiffany, Tim, and Vivianette walk into the ER. Tim expresses severe pain in is pokemon catching IP and MCP joints of his first digit. Tiffany has a possible fracture of her ulna after she and Vivianette chased down a man for taking her squirtle and Tiffany suffered a fall. Vivanette is experiencing pain across the 2nd thru 5th MCP joints for beating up the jerk that made Tiffany fall. What specific images can be taken to best demonstrate the IP and MCP of the first digit for Tim, the ulna for Tiffany and the 2nd thru 5th MCP for Vivianette

Tim: AP and PA oblique thumb

Tiffany: AP and Lateral forearm

Vivianette: PA Oblique Hand, "Fan" Lateral Hand, and Lateral in Extension and flexion - Lateromedial projections of the hand

20

Taylor goes into the ER with an injury to his elbow. Alicia is working as the technologist that day. Taylor is complaining of severe pain in his elbow, he is unable to move it and the physician on staff believes it may be dislocated. What does Alicia do?

She tells Taylor "awe man.... this is really going to hurt" as she laughs evilly and rubs her hands together. Then she performs two acute flexion projections of the elbow. One for distal humerus, CR perpendicular to the humerus, and one for proximal forearm CR perpendicular to the forearm. Alicia then tells Taylor to suck it up and apologizes for forgetting to shield his gonads!